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A majority of Americans report sleep problems, and over 50 million Americans meet diagnostic criteria for a sleep disorder. Sleep disorders are associated with many impairments in daytime functioning such as work performance, fatigue, and sleepiness. Sleep aid medications can help in the short-term but are not recommended for long-term use.
Cognitive-behavioral therapies show promise yet can be costly and difficult to access in some regions. Since stress and worry are known to contribute to sleep difficulties, mindfulness training may also aid in resolving problems sleeping.
Huberty et al. [PLOS One] tested the effects of a brief daily use of a mindfulness meditation smartphone app compared to waitlist controls on sleep disturbance symptoms among people reporting elevated insomnia symptoms.
The researchers randomly assigned 263 participants (average age=45 years; 75% female; 57% Caucasian) reporting elevated insomnia symptoms (an Insomnia Severity Index Score >10) to an app-based mindfulness training or a waitlist control. Many of the participants reported having received prior diagnoses such as insomnia (25%), restless leg syndrome (22%), sleep apnea (16%), night terrors (12%) and narcolepsy (5%).
The mindfulness group was assigned to meditate at least 10 minutes daily using the smartphone Calm app over an 8-week period. The Calm app is a commercially available app containing guided meditations derived from Mindfulness-Based Stress Reduction (MBSR) and Vipassana meditation.
Self-report ratings of daytime fatigue, daytime sleepiness, and cognitive and somatic pre-sleep arousal were assessed at baseline, mid-treatment (4 weeks) and post-treatment (8 weeks). Participants in the mindfulness group also kept a daily sleep quality diary for the 8-week period.
The results showed that the mindfulness group spent an average of 15 minutes per day using the Calm app. At post-treatment, the mindfulness group reported significantly greater decreases in fatigue (d=0.23), daytime sleepiness (d=0.30), and cognitive (d=0.33), and somatic pre-sleep arousal (d=0.46) than controls. Mindfulness participants also reported significant improvements in sleep quality (d=0.13) over time, reporting that they fell asleep faster (d=-0.03) and slept longer (d=0.90).
This experimental study shows a mindfulness training app reduces pre-sleep arousal and daytime fatigue and sleepiness in persons reporting sleep difficulties. App users also reported improved sleep quality. These results are important because they show the promise of an easily-accessed, inexpensive, non-intensive mindfulness training people can perform on their own at home.
The study is limited by reliance only on self-report measures and a control group that received no intervention nor completed sleep diaries. It is possible that any app supporting daily wellness and motivating new behavior could lead to similar improvements in sleep.
Huberty, J. L., Green, J., Puzia, M. E., Larkey, L., Laird, B., Vranceanu, A.-M., Vlisides-Henry, R., & Irwin, M. R. (2021). Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial. PLOS ONE, 16(1), e0244717.
Link to article
The human heart beats about 100,000 times per day. The time interval between each heartbeat changes from moment to moment. Heart rate variability (HRV) is a measure of these time fluctuations between heartbeats over time. When relaxed, our hearts show greater momentary beat-to-beat variation, and so greater HRV. This is due to the predominance of parasympathetic over sympathetic nervous system activity when we are not under stress. Researchers consider increases in HRV to be an objective measure of stress reduction.
Preliminary studies show mindfulness meditation increases HRV. However, these studies often rely on one-time measurements, leaving little known about the persistence of HRV changes over time. Kirk et al. [PLOS One] studied short- and longer-term changes in HRV before, during, and after an app-based mindfulness training compared to two control groups. The study is unique in obtaining HRV measures in participants’ home environments rather than in a laboratory setting.
The researchers randomly assigned 90 Danish participants (average age = 37 years; 70% female) to a 10-day mindfulness training using the Headspace app, a 10-day app-based music listening control condition, or a no-intervention control. The Headspace guided meditation sessions were 20-minutes in length on days 1-5, and 30-minutes in length on days 6-10. Mindfulness training included focused-attention on the breath and body, awareness of mind-wandering, and developing a non-judgmental attitude.
The music listening app consisted of a playlist of 20 two- to four-minute music tracks offered in 20- and 30-minute installments. The inactive control group conducted their lives as usual during the 10-day intervention period.
All participants had their HRVs continuously monitored using a wearable device while going about their normal daily activities for 48 hours prior to and 48 hours following the intervention period. In addition, participants in the mindfulness and music groups had their HRVs monitored whenever they were using the assigned intervention app, allowing researchers to monitor HRV over the 10 intervention days. They also completed self-report measures of perceived stress and mindfulness (the Mindful Attention Awareness Scale).
Results showed significantly larger increases in mindfulness (η2p=.14) and larger decreases in perceived stress (η2p=.08) after intervention for the mindfulness group over each control groups. The mindfulness group showed significantly greater increases in average daytime (η2p=.12) and nighttime (η2p=.30) HRV after intervention than each control group.
Increases in post-intervention daytime HRV (r=.47) and nighttime HRV (r=.44) were significantly correlated with total minutes of meditation practice during intervention. Music group nighttime increases in HRV were also correlated with time spent listening to music (r=.36).
There were also acute HRV effects that occurred while meditating or listening to music. The mindfulness group showed a significant 13 millisecond average increase in HRV over baseline while meditating. The music group showed a significant 9 millisecond increase over baseline while listening to music.
The mindfulness group showed a respiration rate that significantly decreased by four breaths a minute compared to baseline while meditating, while the music group did not slow respiration while listening to music.
The study shows that an app-delivered 10-day mindfulness intervention increases HRV while meditating, and that increases in HRV persist for 48 hours after the 10-day training period. Total minutes of meditation correlated with increased HRV. The study demonstrates the feasibility of assessing HRV as an objective biomarker in naturalistic environments outside the laboratory. The analysis in the study is limited by not adjusting for respiration rate and tidal volume which can directly impact HRV.
Kirk, U., & Axelsen, J. L. (2020). Heart rate variability is enhanced during mindfulness practice: A randomized controlled trial involving a 10-day online-based mindfulness intervention. PLOS ONE, 15(12), e0243488.
Research shows that mindfulness practice can reduce pro-inflammatory biomarkers related to illness onset and disease progression. Little is known, however, about how meditation-induced changes in inflammation are connected to brain activity. Mindfulness training can reduce fear in response to threat by reducing activity in the amygdala. It can also increase or decrease response to various rewards by modifying activity in the ventral striatum. Fear reduction and reward enhancement are important aspects of how mindfulness facilitates well-being.
Dutcher et al. [Psychoneuroimmunology] studied whether meditation-induced changes in brain activity were correlated with changes in pro-inflammatory biomarkers among breast cancer survivors.
The researchers assigned 22 female breast cancer survivors who had completed primary treatment (average age = 47 years; 60% white) to a Mindfulness Awareness Practices program developed by the UCLA Mindful Awareness Research Center. Participants met in weekly 2-hour groups over 6 weeks.
Class sessions included didactic material on mindfulness, relaxation, and mind-body relationships, and experiential practice with a variety of meditation techniques to cultivate positive emotions.
Participant blood was collected by venipuncture before and after intervention to quantify levels of two pro-inflammatory biomarkers, the cytokine Interleukin-6 (IL-6) and C-reactive protein (CRP). Participants also underwent fMRI brain scans before and after intervention.
Participants engaged in two tasks while being scanned. The first task, intended to stimulate amygdala activity, was a threat reactivity task involving viewing images of threatening facial expressions interspersed with an emotionally neutral task. The second, intended to stimulate ventral striatum activity, was a reward reactivity task involving viewing positively emotionally-toned images of landscapes, sunsets, smiling faces interspersed with neutrally emotionally-toned images of common household objects.
Results showed the women reported significantly decreased depression (d=-0.57) and increased subjective well-being (d=0.57) after intervention. Right amygdala activity in response to threatening images significantly decreased after intervention (d=-0.49). Left ventral striatal activity in response to the landscapes and sunsets significantly increased after intervention (d=0.54).
There were no significant changes in IL-6 or CRP levels after intervention; however, there was a significant association between increases in left ventral striatal activity and changes in IL-6 and CRP. That is, the greater the increase in left ventral striatal activity to landscapes and sunsets, the lower the IL-6 (β=-1.64) and CRP levels (β=-3.07).
The study shows that a mindfulness training program delivered to breast cancer survivors in a group format is associated with changes in brain activity in the amygdala and ventral striatum immediately after intervention. Increased ventral striatal reactivity to positively emotionally-toned nature images inversely correlated with pro-inflammatory markers.
The study lacked a control group, had a small sample size, and included group social support, thus limiting any interpretation of causa
Dutcher, J. M., Boyle, C. C., Eisenberger, N. I., Cole, S. W., & Bower, J. E. (2021). Neural responses to threat and reward and changes in inflammation following a mindfulness intervention. Psychoneuroendocrinology, 125, 105114.
Delivering bad news to patients is one of the many challenges physicians face. The exchange can be emotionally taxing for both the physician and patient, and if communicated poorly, can lead to misunderstanding, emotional devastation, and low treatment compliance. Cultivating a mindful state before delivering bad news may potentially help physicians communicate bad news more skillfully.
Mengin et al. [Journal of Surgical Education] conducted a pilot study to test if a brief guided mindfulness meditation could improve bad news communication skills in medical residents.
The researchers randomized 53 French ear, nose, and throat (ENT) residents to a brief mindfulness meditation and a control condition. Participants in both conditions attended a 45-minute lecture on how to communicate bad news to patients. After the lecture they completed self-report measures of anxiety, fear of evaluation, and mindfulness (Mindful Attention Awareness Scale, MAAS).
The residents completed a bad news consultation training session that consisted of preparation, simulation, and post-simulation phases. The preparation phase included having residents self-rate their stress and self-confidence and then listen to either a 5-minute guided mindfulness meditation audio track or an information-only control audio track on the definition of atoms.
After listening to the audio tracks, residents again rated their stress and self-confidence. In the simulation phase, residents engaged in an 8-minute simulated consultation in which they disclosed a diagnosis of laryngeal cancer to a person acting as a patient.
A psychiatrist and ENT specialist blind to the resident’s study group rated each resident on skill performance. Ratings were made for respect, efficacy, knowledge, communication, and overall impression.
The evaluators also passed or failed each resident based on their belief that the resident was now ready to perform bad news consultations independently. In the post-simulation phase residents again rated their stress, self-confidence, and empathy. The patient actors also rated resident empathy.
The results showed that the mindfulness group performed significantly better overall in the simulated bad news consultation (Cohen’s d=0.67) compared to controls, and this effect was driven, in part, by significantly higher scores on knowledge and communication skills.
Only 4% of residents in the mindfulness group failed their simulated consultation, while 30% of the controls failed. There were no between-group differences in either self-rated empathy or empathy as perceived by the patient actor. In addition, there were no differences in perceived stress before and after the mindfulness meditation.
The study shows that a brief mindfulness meditation immediately prior to a simulated bad news consultation significantly improves resident bad news communication. Based on medical specialist evaluator reports, residents who briefly meditate communicate better, appear more knowledgeable, and are less likely to fail a communication task.
The meditation proved effective even though it did not affect residents’ perceived stress or empathy. The fact that the meditation enhanced performance in the absence of prior extensive training suggests that physicians could use mindfulness as a stand-alone technique prior to engaging in bad news delivery to patients. The study is limited by use of a simulation performance rating scale not previously validated.
Mengin, A. C., Kayser, C., Tuzin, N., Perruisseau-Carrier, J., Charpiot, A., Berna, F., Lilot, M., & Vidailhet, P. (2020). Mindfulness Improves Otolaryngology Residents’ Performance in a Simulated Bad-News Consultation: A Pilot Study. Journal of Surgical Education.
Work-related stress is a major cause of employee dissatisfaction, absenteeism, turnover, and ill-health. Hospital healthcare workers face a number of significant work-related stresses including the physical, cognitive, and emotional demands of caring for seriously ill people. Hospitals can benefit from interventions designed to reduce occupational stress, retain personnel, and prevent burnout.
Errazuriz et al. [Journal of Psychiatric Research] tested the efficacy of a mindfulness intervention on hospital healthcare worker distress when compared to a stress management course or waitlist control.
The researchers randomly assigned 105 Chilean non-physician hospital healthcare workers (average age = 40 years; 98% female) to Mindfulness Based Stress Reduction (MBSR), a stress management course, or a waitlist control. Twenty-three percent of participants met the pretest cut-off criteria for being psychologically distressed.
MBSR and stress management groups met in 2-hour weekly group sessions for 8 weeks. The MBSR intervention followed the usual MBSR protocol minus the all-day retreat. The stress management course was a pre-existing hospital program comprised of lectures, interpersonal support and experiential activities on topics such as visualizing strengths, relaxation, self-care, resilience, and seeking social support.
Participants were assessed at baseline, after intervention, and at 4-month follow-up on self-report measures of general and occupational psychological distress, job satisfaction, perceived stress, and mindfulness (Five Facet Mindfulness Questionnaire, FFMQ). Cortisol in saliva, a stress hormone, was collected three times over the course of a single day at baseline and post- intervention.
Participant attrition was high, with 73% completing at least one measure at post-intervention, and 50% completing at least one measure at follow-up.
Immediate post-intervention results showed the MBSR group had significantly less distress and reported higher job satisfaction than the stress management and waitlist groups. The MBSR group also scored significantly higher on FFMQ “describing” and “acting with awareness” facets than stress management group.
For the physiological marker, the MBSR group had a significantly smaller increase in cortisol during the first 45 minutes after morning awakening relative to the comparison groups.
There were no significant differences between stress management and waitlist controls on any measure. At 4-month follow-up, the MBSR group showed significantly less social role dysfunction and significantly higher FFMQ “observing” compared to the stress management group.
The study shows MBSR is more effective than a hospital-delivered stress management course in reducing short-term distress and increasing short-term work satisfaction in Chilean hospital healthcare workers. Most of these effects did not persist on 4-month follow-up, suggesting the need for continued practice to maintain gains. The study is limited by its small sample size and high rate of attrition.
Errazuriz, A., Schmidt, K., Undurraga, E. A., Medeiros, S., Baudrand, R., Cussen, D., Henriquez, M., Celhay, P., & Figueroa, R. A. (2020). Effects of mindfulness-based stress reduction on psychological distress in health workers: A three-arm parallel randomized controlled trial. Journal of Psychiatric Research.
Children with cancer often have significant cognitive, emotional, behavioral, and academic problems. These result not only from the illness itself, but also the anxieties associated with diagnosis and prognosis, the negative side-effects of oncology treatments, and the lengthy separations from familiar settings and social supports entailed by hospitalization. Psychosocial interventions are needed that can more effectively bolster children’s resilience over the course of arduous treatment.
Abedini et al. [Mindfulness] assessed the value of a modified version of Mindfulness-Based Cognitive Therapy for Children (MBCT-C) in reducing internalizing psychological problems (anxiety, depression, and somatization) and attentional problems in school-age children undergoing hospitalization for cancer.
The researchers randomly assigned 40 Iranian children hospitalized for cancer (age range = 11-13 years; 53% male) who met the diagnostic criteria for acute stress disorder and showed elevated internalizing and attentional problems to a modified version of MBCT-C or to treatment as usual. The children were continuously hospitalized throughout the length of the intervention.
MBCT-C was delivered in the Farsi language to small groups of 2-4 participants meeting 5 times a week. The standard MBCT-C protocol was modified to meet the children’s physical, motivational, and attentional needs and the demands of the hospital schedule. Group sessions were shortened to 45 minutes each, delivered over a shortened 4-week time-course, and without the usual raisin, yoga, and mindful movement meditations.
Treatment as usual included limited medical social worker support and a playroom available for 2 hours daily. Children were assessed before and after treatment and at 2-month follow-up for internalizing behavioral problems and attentional difficulties using a parent-completed behavioral checklist, and a child-completed self-report inventory.
The results showed significantly greater reductions in parent-rated (η2=.53) and child-rated (η2=.57) internalizing symptoms for the mindfulness group compared to controls. Parent-rated symptoms decreased 19 points and child-rated symptoms 20 points, while control parent- and child-rated symptoms dropped only 1 point.
The mindfulness group also showed significantly greater decreases in attentional problems compared to controls on both parental (η2=.76) and child ratings (η2=.36). Parent-rated attentional problems decreased 15 points and child-rated attentional problems decreased 19 points for the mindfulness group while the control group remained essentially unchanged.
The study shows that MBCT-C modified to meet the needs of hospitalized children with cancer and acute stress disorder can significantly improve symptoms of anxiety, depression, somatization, and impairments in attention compared to treatment as usual. These improvements are sustained for at least 2-months after intervention.
The study is limited by the absence of post-intervention outcome ratings by clinicians blind to group assignment, and the lack of an active control group which also promoted social interaction with other children with cancer.
Abedini, S., Habibi, M., Abedini, N., Achenbach, T. M., & Semple, R. J. (2020). A Randomized Clinical Trial of a Modified Mindfulness-Based Cognitive Therapy for Children Hospitalized with Cancer. Mindfulness.
Many critical tasks in daily life require sustained attention under stressful circumstances (e.g., air traffic control, combat, and emergency medical response) despite the fact that stress can deplete attention by overtaxing cognitive resources. Lapses of attention increase under conditions of acute stress.
Mindfulness training can have beneficial effects on attention and stress, and researchers are interested in knowing the degree to which it can prevent stress-induced attentional impairment. Piil et al. [Journal of Cognitive Enhancement] tested the effects of mindfulness training compared to cognitive performance training on sustained attention following a stressor.
The researchers randomly assigned 48 Danish university students and staff members (average age = 38 years; 58% female) to either 30 days of mindfulness training using the Headspace app, or 30 days of cognitive training using the NeuroNation app. Headspace is a meditation application that teaches core mindfulness skills through guided audio meditations that include mindful breathing, open monitoring, and body scanning. NeuroNation is a cognitive training application consisting of short games intended to strengthen working memory, perceptual accuracy, verbal and arithmetic skills, and logical reasoning.
Participants were instructed to use the apps 10 minutes daily for 10 days, 15 minutes daily for the next 10 days, and 20 minutes daily for the final 10 days.
At baseline and after completing one month of training, participants were exposed to a cold pressor stress task and then immediately asked to perform a sustained attention task. The cold pressor task in known to increase stress as measured by increases in sympathetic nervous system arousal (heart rate, blood pressure, stress hormones). Participants were instructed to put their non-dominant hand in a tank of circulating ice water until it became too uncomfortable to keep it there.
Participants were then placed in front of a computer screen and instructed to press a space bar whenever a numeral between 0-9 appeared, except when the numeral was “3.” The researchers measured the percent of times participants refrained from pressing the space bar when a “3” appeared. Participants were also assessed on a measure of dispositional mindfulness (the Mindfulness Attention Awareness Scale) before and after training.
The results showed the mindfulness group performed significantly better on the computer-based sustained attention task than the cognitive training group (partial η2=0.12; medium effect size). The amount of total time spent using the Headspace app correlated with better sustained attention performance (r=.56) while time spent on the NeuroNation app did not (r=.23). The mindfulness group had significantly higher mindfulness scores than the cognitive training group immediately following the intervention (partial η2=0.28; large effect size).
Before training, the longer participants kept their hand in the ice water, the poorer their subsequent ability to sustain attention (r=-.64 for mindfulness trainees; r=-.76 for controls). After training, this held true for the cognitive trainees (r=-.71) but not for the mindfulness trainees (r = .10). If keeping one’s hand in ice water longer is more physiologically stressful, this means stress levels were no longer correlated with attentional degradation within the mindfulness group.
The study shows that an app-based mindfulness training can improve sustained attention after a stressor and mindfulness disposition compared to a cognitive training app. The study is limited by its lack of physiological stress measures, an assessment of sustained attention under non-stress conditions, and the unknown amount of time each group spent using the app. There is also inconclusive efficacy research on the NeuroNation app.
Piil, F., Axelsen, J. L., Staiano, W., & Kirk, U. (2020). Mindfulness Passes the Stress Test: Attenuation of Behavioral Markers of Mind Wandering During Acute Stress. Journal of Cognitive Enhancement.
[Link to study]
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